Provider Demographics
NPI:1235458886
Name:COUNTA, WENDI
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:COUNTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1101
Mailing Address - Country:US
Mailing Address - Phone:530-601-0026
Mailing Address - Fax:
Practice Address - Street 1:2261 S WATNEY WAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6757
Practice Address - Country:US
Practice Address - Phone:707-920-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator